Veterans Affairs officials knew four years ago that VA centers across the nation were engaging in alleged "gaming strategies" to improve review scores for scheduling veterans' medical appointments, a government memo says.

The American Legion published the 2010 memo included in the interim VA Office of Inspector General Report on its website last week.

The American Legion called it a "smoking gun" document.

El Pasoans, including a longtime veteran's advocate, say complaints about long wait times for medical appointments, treatment and medications for mental illness are endangering the health of veterans in the region.

"This memo clearly shows that VA's Central Office (VACO) has long-known about these gaming strategies at some of its facilities, yet has done nothing to effectively eliminate such practices," Daniel M. Dellinger, national commander of the American Legion in Washington, D.C., said in a statement.

"What has allegedly been happening at Phoenix and other VA hospitals nationwide was happening in 2010," Dellinger said.

The American Legion said that one such "gaming strategy" that VA facilities used to improve their scores on access measures included canceling appointments for vets who failed to check in 10 to 15 minutes before their appointment time.

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"Patients are informed that it is medical center policy that they must check in early and, if they fail to do so, it is in the medical center's right to cancel that appointment. This is not patient-centered care," according to the 2010 VA memo.

Marty Callaghan, spokesman for the American Legion in Washington, D.C., said that the American Legion did not receive a response from VA regarding the memo it obtained since showing it to the VA on May 20.

The Veterans Affairs in Washington, D.C., has not returned messages on whether the agency charged with the health care of veterans ever followed up on the memo's instructions.

William Schoenhard, former deputy undersecretary for Health Operations and Management, and author of the April 2010 memo titled "Inappropriate Scheduling Practices," left the VA last year.

El Paso businessman Jaime Hervella says his son, a Vietnam War-era veteran, was unable to get his medication for schizophrenia from the VA center in El Paso.

"His medication ran out, and he needed it badly," Hervella said. "He went to try and see a doctor, but left in frustration after waiting for hours. There are many other veterans like him who need to be seen by a doctor to get medication refills approved, and they can't get someone to see them. We've heard from other vets that they are overwhelmed by all the new veterans, and that they often run out of supplies and medications."

Hervella is concerned that the lack of medication for diagnosed schizophrenics in the veteran population could lead to unfortunate incidents with individual veterans and their families, as well as in negative encounters with law enforcement.

Ron Holmes, 66, a former Marine and longtime veterans advocate in El Paso, said he's heard complaints from local veterans about having to wait months for critical surgeries and treatment through the El Paso VA center, and he is waiting on long overdue surgery.

"Sometimes I feel like I am being punished for helping other vets with their health care claims," Holmes said, "but I know there are others out there like me who got sidelined because they are helping vets. I've had people from the VA system say that they've been told not to talk to me or else they will get in trouble with their bosses."

Over the past 16 years, Holmes processed 4,500 veterans' claims free of charge, and continues to assist vets who were denied on their initial claims. He is licensed to assist with claims preparation and national veterans organizations often refer veterans to him.

Although Holmes can no longer walk, he still assists veterans three days a week at the American Legion Post 58 in Northeast El Paso. "I will continue to be there, as long as any of the veterans need me to help," Holmes said.

Sheila Austin, spokeswoman for the VA center in El Paso, said the agency cannot discuss individual cases for reasons of privacy, and encourages veterans to bring their concerns to the center.

The El Paso VA center released a statement in response to the other issues raised that affect the nearly 50,000 veterans who live in El Paso County.

"VA has redoubled its efforts to provide quality care to veterans and has taken steps at national and local levels to ensure timely access to care," the statement said.

The Veterans Health Administration has developed a coordinated, systemwide initiative to accelerate care to veterans and enhance clinic capacity to help the veterans get care sooner. The VA's care model includes primary, mental health and specialty care in-house and through community resources when these are not available in-house, Austin said.

The Veterans Health Administration is the health component of the Veterans Affairs Department.

"The Accelerating Care Initiative will also be utilized to ensure veterans receive mental health services while we continue to recruit and fill additional positions, some of which were added as a result of increased demand for services," Austin said.

The Department of Veterans Affairs has been under fire for its long waiting times for medical appointments and more recently for allegations that it maintained secret waiting lists of ill veterans who died before they were given doctor appointments.

U.S. Rep. Beto O'Rourke, D-El Paso, who recently voted in favor of the Department of Veterans Affairs Management Accountability Act (H.R. 4031) — legislation to make leadership at the VA more responsive — serves on the House of Veterans Affairs Committee.

In a statement, he said that El Paso's Veterans Health Administration Director John Mendoza has assured him that the VA does not maintain a secret list of veterans' wait times.

"We have long known that veterans across the country wait too long to receive healthcare and my hope is that recent events will lead to real reform of a grossly inadequate system," O'Rourke said.

"By the end of the week, I will be sending a letter to the El Paso Veterans community outlining the steps I have taken to improve inadequate access to healthcare at the El Paso VA, and specifically what I have done in response to the recent allegations at the Phoenix VA," he said.